Updated11-2-2009
Flu activity do to the novel H1N1 strain (Swine Flu) has increased dramatically in the Hill Country and the greater Austin area over the last 4 weeks. The US Centers for Disease Control (CDC) and the Texas Department of State Health Services (DSHS) have continued to track the extent of the outbreak. Both government agencies continue to make frequent updates on their web sites.
Locally, urgent care centers and emergency rooms have seen a very large increase in volume due to this illness. The vast majority of cases have been unusually mild compared to seasonal influenza (the flu we see every year). The major difference has been a somewhat more rapid increase in numbers of people seen than during a typical flu season.
A vaccination to prevent the novel H1N1 has been delayed in production and slow in distribution to providers. According to sources at DSHS, thus far (as October 22) they have only received 2/3 of the vaccine promised them for October from manufacturers. Sources at DSHS state they are distributing it to providers with priority going to providers that provide services to children under age 5. A call to local pediatric offices at publication time revealed none had received any vaccine. DHHS continues to refer inquires regarding the vaccine and it's distribution to "211" information.
Certain groups of people have been identified as being at high risk for complications from H1N1 influenza. In light of the lack of availability of vaccine, what should providers and the public do to protect those identified as being at high risk?Continued From Newsletter
The CDC has identified the following groups of persons to be at high risk for complications from the novel H1N1 flu stain: 1) Children under 5 years of age, particularly those under 2 years of age, 2) Pregnant women, 3) Persons with chronic medical conditions such as asthma, diabetes, heart disease, and neurological disease. Those with these conditions have been identified as high priority to receive the new H1N1 vaccination.
For these individuals, the H1N1 vaccine could be life saving. DSHS currently is directing the public to continue to call “211” information as the source for information on the availability and location to receive the H1N1 vaccine.
Persons who have a high risk condition that become ill with an “influenza like illness” (ILI) should be treated with an antiviral such as Tamiflu. Also, persons in the household of someone with a high risk condition who develop symptoms of an “ILI” (fever over 100 associated with either cough, sore throat, or runny nose), should be isolated from the high risk person and placed on an antiviral such as “Tamiflu”. In fact, the safest course when there is flu in the household of a high risk individual is to place all members in the household on Tamiflu including the high risk individual.
The CDC has been relatively clear this year with regard to the use such as Tamiflu in individuals that are not considered at high risk. Essentially the CDC has come out in multiple bulletins stating “they don’t need it”. So essentially, if there is no high risk members in the household, Tamiflu is not recommended by the CDC.
The CDC has been careful not to recommend against the use of Tamiflu in low risk individuals. It is, however, clearly left to personal preference. Tamiflu continues to be “indicated” (OK to use) in both high risk and low risk individuals. However, for those of us at low risk for complications, it is more of a “cost vs benefit” analysis whether we choose to use the antiviral medication. Tamiflu is expensive and for most of us this is a relatively mild strain of flu. For most people who do not work around or live with high risk individuals, we must consider whether the $120 – 130 price of the Tamiflu is worth the day or so sooner it may get us back to work or school.
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